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Hamstring Injury Physiotherapy

A hamstring injury is a very common injury especially in sports, and is often called as a "pulled hamstring".

The word "pulled muscles" is a pretty accurate description of how the muscle got injured/happened in the first place, which is the hamstring muscle was pulled or stretched beyond its maximum limits, and leads to hamstring muscle fiber tearing.

Severity is divided into 3 grades as below

grades of hamstring muscle injury

Depending on how severe your pulled hamstring muscle injury is, you may see the range of symptoms as below:

  1. Grade 1 Hamstring Injury any signs of pains or strains may not be present until the activity is over. The might be cramping or tightness or pains when the hamstrings are stretched or contracted. Around or less than 1-5% muscle fibers torn

  2. Grade 2 Hamstring Injury presents with immediate pain, more severe then the grade 1 level. It is often confirmed on stretch and contraction of the hamstring muscle. Between 10-50% (or more) muscle fibers torn.

  3. Grade 3 Hamstring Injury this level of injury is very serious, often accompanied with burning or stabbing pain. Patients with this Grade 3 injuries usually cannot walk  due to pain and poor muscle control. In this types, the muscle is completely torn (100% rupture), and you may be able to see a large bulge or lump of muscle tissues above a depression where the tear is.

hamstring muscle injury risk factors

There are various proposed risk factors which may play a role in hamstring injuries: 

  • Older in age age
  • Previous hamstring injury
  • Limited hamstring flexibility (hamstring muscle tightness, a very common condition)
  • Increased fatigue or tired
  • Poor core strength and/or stability
  • Strength imbalance
  • Ethnicity
  • Previous calf injury
  • Previous moderate to severe knee injury
  • Osteitis pubis
  • Increased quadriceps flexibility was inversely associated with hamstring strain incidence in a group of amateur Australian Rules footballers
  • Players presenting certain polymorphisms, IGF2 and CCL2 (specifically its allelic form GG), might be more vulnerable to severe injuries and should be involved in specific prevention programmes
  • Tight hip flexors (another very common condition)
  • previously associated lumbar spine abnormalities.

Kicking and executing abdominal strengthening exercises with straight legs have been identified as possible contributory causes of lordosis. The anatomical reason seems to be that the iliopsoas muscle group is primarily involved in kicking and straight leg raising or straight leg sit-up exercises and contributes to strengthening this muscle'. Therefore, it is possible that certain athletic activities and training methods which exacerbate postural defects may also predispose the player to injury.

During activities like running and kicking, hamstring will lengthen with concurrent hip flexion and knee extension, this lengthening may reach the mechanical limits of the muscle or lead to accumulation of microscopic muscle damage.  There is a possibility that hamstring injuries may arise secondary to the potential uncoordinated contraction of biceps femoris muscle resulting from dual nerve supply.

Another debate is on hamstring variation in muscle architecture.Short head of biceps femoris(BFS) possess longer fascicles (which allow for greater muscle extensibility and reduce the risk of over lengthening during eccentric contraction) and a much smaller cross section area compared to Long head of biceps femoris (BFL). Whereas BFL presents with shorter fascicles compared to BFS which undergo repetitive over lengthening and accumulated muscle damage.

Excessive anterior pelvic tilt will place the hamstring muscle group at longer lengths and some studies proposed that this may increase risk of strain injury.

hamstring injury Physiotherapy starts with r.i.c.e.r.

No matter what grade the injury is, physiotherapy intervention will begin with the RICER approach to all acute injuries:

  • Rest your injured hamstring muscle
  • Ice and cold therapy to decrease inflammation and swelling
  • Compression reduces local bleeding and inflammation
  • Elevation above the heart level helps to improve circulation and reduces pain and inflammation
  • Referral for physiotherapy/medical intervention

RICER is basic but it's a very important basic that needs to be done right and immediately.

After the 72 hours of the RICER (early stage), and depending on the severity of your hamstring muscle injury, then we can start more active physiotherapy intervention, and this should be started as soon as possible.

Please be assured that we believe in little-to-no pain during physiotherapy, and though there may be some discomfort and fear, however, by starting active physiotherapy early, you will accelerate your recovery process by a lot.

Hamstring muscle injury physiotherapy may include:

Regular maintenance with deep tissue release and sports massage will improve the performance of the hamstring as well as decrease risks of recurrence of this injury (see more advantages of regular deep tissue release and sports massage here).

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Phoenix Rehab Physio Services

Phoenix Rehab Group works with specialist physiotherapists and rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients.


Patients who sustained injuries to their elbows, forearms, hands, wrists (sprains and fractures) and fingers, usually will benefit / require Hand Therapy to

  1. manage and decrease hand pains
  2. improve range of motion, strength and dexterity
  3. increase the function of their hand following injuries or post-operations

Commonly treated hand pain injuries includes


Clinical Pilates is a form of physical exercise that focuses on posture, core stability, balance, control, strength, flexibility and breathing.

It is a system of safe and effective exercises, which meet specific individual needs, to treat a wide range of injuries and conditions.

You may do Pilates as matwork or with the reformer or both, and every session will be customized 100% to your fitness, injury and tolerance.


  • Cupping TCM
  • Auricular Therapy TCM
  • Herbal TCM Medicine & Supplementation


Sports and deep tissue release massage helps to increase nutrient-rich blood flow to tired, tight and tense muscles to accelerate recovery and  shorten downtime / recovery period required.

It also prevents muscles from scar tissue micro-tears (and potential ruptures), and increases muscle performance. Having regular deep tissue and sports massage will keep your muscles healthy and fit with body/movement-confidence.

Read the benefits of regular deep tissue release therapy here.


All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB).

See our entire team here with introductions and their specializations.

At the first session, our specialist physiotherapists will carry out a thorough assessment, helping them to select the most appropriate treatment to help you recover as well as provide treatment in the same session.

Follow up sessions are inline to provide expert treatment for your pain as well as prescribing specific exercises to reduce your risk of re-injury and giving you a long term solution.

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We prefer not to rely on advertising - instead, we prefer and appreciate the goodwill and positive reinforcement from patients. When you have the chance, please tell your family, friends and physicians about the positive results and experience you have had in our physio clinics.

book an appointment today
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